Title: Mother-infant bonding disorders and use of Parental Bonding Questionnaire in clinical practice.
Abstract: Ian Brockington's paper is a most important review of the perinatal psychiatry research and practice in recent times. The paper proposes to recognize mother-infant relationship disorders as specific conditions to be diagnosed as such by psychiatrists and general practitioners. Brockington states that there is no single entity and that this is a group of overlapping clinical states, with various morbid elements in the relationship between the mother and the infant. They include a distressing lack of maternal feeling, irritability, hostility and aggressive impulses, pathological ideas and outright rejection. These disorders are quite common in mothers referred for psychiatric help and are present in 22% of post-partum referrals (1) and in 29% of mothers diagnosed with post-natal depression (2). There are three different manifestations of bonding disorders: a) mild disorders (delay, ambivalence or loss in maternal response); b) rejection (threatened or established); c) pathological anger (mild, moderate or severe).
When the mother experiences delay or loss of maternal emotional response, she may express disappointment about her feelings towards her infant (e.g., that she has no feelings, or she feels estranged or distant from him, or she feels that he is not her baby, or that she is baby-sitting for someone else).
When a mother experiences pathological anger towards the infant, she may have a milder form (an experience of anger which is controlled with difficulty) or she may have an impulse to harm or kill the child, or she may lose control at a verbal level and shout and scream at the baby. When the presentation of anger is more pronounced, this may result in handling the baby roughly (e.g., throwing it into the cot or jerking his limbs, shaking him, occluding his breathing), or she may strike, beat, bite, burn or throw him or make a deliberate attempt to kill him.
The third presentation of a bonding disorder is the rejection of the infant (when the mother expresses strong negative feelings about the child: dislike, hatred and regret about his birth). There is absence of affectionate behavior such as kissing, cuddling, cooing, singing, playing. She feels better when away from the infant; she expresses the feeling of being trapped by motherhood. She may express the wish that the infant care is transferred to someone else. She may have the wish that the infant is stolen or dies and she may have run away to escape the care of the infant. All these presentations of bonding disorder have to produce distress and result in an appeal for help from family or professional staff, in order to meet the criteria (2).
The mother-infant interaction is one of the main focuses of perinatal psychiatry. In a recent transcultural study on post-partum depression, the mother-infant interaction was one of the variables assessed to capture the whole spectrum of themes of perinatal illness (3). Leading perinatal psychologists and psychiatrists have developed objective methods of investigating the mother-infant interaction. For the clinician, these methods are sometimes quite difficult to implement. Questionnaires are a very useful tool to evaluate a disordered relationship at the first interview with the mother. This can facilitate the establishment of a treatment plan and the evaluation of treatment progress.
In cases of post-partum depression, the Parental Bonding Questionnaire (PBQ, 2) is best used together with the Edinburgh Postnatal Depression Scale (EPDS, 4), in order to assess the effect of treatment on both variables: depression and difficulties of the mother to relate to her child.
The use of the PBQ allows the clinician to judge the severity of the relationship disorder and even more importantly to evaluate improvement. This is very helpful with the depressed patient, who often does not notice any change. It also enables the therapist to keep the patient hopeful and optimistic, a crucial ingredient in the therapy of depressed patients.
Publication Year: 2004
Publication Date: 2004-06-01
Language: en
Type: article
Indexed In: ['pubmed']
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Cited By Count: 12
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